The Ensign Group Reports Second Quarter 2016 Results

MISSION VIEJO, Calif., Aug. 01, 2016 (GLOBE NEWSWIRE) -- The Ensign Group, Inc. (Nasdaq:ENSG), the parent company of the Ensign™ group of skilled nursing, rehabilitative care services, home health, home care, hospice care, assisted living and urgent care companies, today announced its operating results for the second quarter of 2016, reporting GAAP diluted earnings per share for the quarter of $0.22 and adjusted earnings per share for the quarter of $0.33 (1).

Quarter Highlights Include:

Consolidated GAAP EBITDAR for the quarter was $60.3 million, an increase of 27.2% over the prior year quarter, and consolidated adjusted EBITDAR was $65.5 million, an increase of 30.3% over the prior year quarter(1);

Transitioning skilled revenue mix increased by 130 basis points over the prior year quarter to 55.9% and same-store skilled mix days increased by 35 basis points over the prior year quarter to 30.4%;

Same Store revenue for all segments grew by 6.9% over the prior year quarter, and same store TSA revenue grew by 6.3% over the prior year quarter;

Transitioning revenue for all segments grew by 6.3% over the prior year quarter, and
transitioning TSA revenue grew by 5.8% over the prior year quarter;

Cornerstone Healthcare, Inc., our home health and hospice subsidiary, grew its segment income by 45.2% over the prior year quarter and revenue by $8.5 million to $28.5 million for the quarter, an increase of 42.9% over the prior year quarter; and

Consolidated GAAP revenues for the quarter were up $99.5 million or 32.0% over the prior year quarter to $410.5 million and consolidated adjusted revenues for the quarter were up $92.5 million or 30.4% over the prior year quarter to $396.6 million(1).

(1) See "Reconciliation of GAAP to Non-GAAP Financial
Information".

Operating Results

Commenting on the operating results, Ensign's President and Chief Executive Officer Christopher Christensen said, "While we are very pleased with the contribution of some of our recently acquired operations, the majority of our newer operations continue to have significant upside." Noting that Ensign's adjusted earnings per share was $0.33 for the quarter, which met consensus estimates, Mr. Christensen reiterated that the organization completed the largest acquisition in its history during the quarter and has 72 recently acquired and 29 transitioning skilled nursing and assisted living operations, combining for 49% of Ensign's current portfolio as of July 1, 2016. He added,
"Compared to any other time in our organization's history, there is a substantial amount of organic growth potential inherent in our existing operations."

Mr. Christensen announced that after increasing its annual earnings guidance last quarter, management determined that some of the expected performance will take a few quarters longer to realize than initially anticipated. "As we continue to absorb a significant number of new operations across our organization, our focus has been to take the necessary steps to set these operations up for success over the long-term," Christensen said. He added that "as a result of our deliberate efforts to ensure a proper transition for our new operations, some of the performance we expected to occur in the later part of 2016 will carry over into 2017. Therefore, we are revising our 2016 adjusted earnings
guidance to $1.35 to $1.42 per diluted share for 2016 and are reaffirming our 2016 revenue guidance of $1.625 billion to $1.660 billion."

Chief Financial Officer Suzanne Snapper added "in order to provide our investors with more clarity regarding our organic growth expectations, we are also announcing 2017 guidance of $1.818 billion to $1.842 billion in revenues and $1.62 to $1.70 adjusted annual earnings per diluted share." Ms. Snapper also indicated that although the performance of the newer acquisitions has been slower than expected, many of the improvements management anticipated are beginning to take effect and she expects them to continue into the remainder of 2016 and into
2017.

"Our operational leaders are fully engaged on all fronts to identify and overcome weakness wherever it occurs and, because of them, we remain confident that Ensign's future - both near- and long-term - is very bright," Christensen noted. "As we've often reminded you, whenever we've seen an unusual surge in growth over a short period of time, we naturally expect a temporary impact to our short-term earnings, however, we have always taken the long view of our business, and we are excited about the enormous opportunity to unlock the value in our existing portfolio," he said.

Ms. Snapper also added, "Our balance sheet remained strong, with approximately $263.0 million of availability on Ensign's new $450 million credit facility as of August 1, 2016, which also has a
built-in expansion option, and 32 unlevered real estate assets that add additional liquidity." Ms. Snapper also reported that consolidated revenues for the quarter were up 32.0% over the prior year quarter to a record $410.5 million, GAAP EBITDAR for the quarter was $60.3 million and consolidated adjusted EBITDAR for the quarter was $65.5 million, an increase of 30.3 % over the prior year quarter.

GAAP diluted earnings per share were $0.22 and fully diluted adjusted earnings per share were $0.33 for the quarter. GAAP net income was $11.3 million and adjusted net income was $17.1 million. A discussion of the company's use of non-GAAP financial measures is set forth below. A reconciliation of net income to adjusted EBITDAR and adjusted
EBITDA, as well as a reconciliation of GAAP earnings per share and net income to adjusted net earnings per share and adjusted net income, appear in the financial data portion of this release.

More complete information is contained in the Company's 10-Q, which was filed with the SEC today and can be viewed on the Company's website at http://www.ensigngroup.net.

Quarter Highlights

During the quarter, the Company paid a quarterly cash dividend of $0.04 per share of Ensign common stock. Ensign has been a dividend-paying company since 2002 and has increased its dividend
every year for 14 years.

Also during the quarter and since, the company announced the acquisition of nineteen skilled nursing operations and one hospice business. The following skilled nursing operations are subject to long-term leases:

In addition, Ensign has opened six Healthcare Resorts. The Healthcare Resorts offer world-class rehabilitation and healthcare services in a resort-like setting as well as offering private extended-stay suites for patients requiring additional assistance before they return home. The new Healthcare Resorts include:

The Healthcare Resort of Kansas City, with a 70-bed licensed transitional care operation and 30 private assisted living suites;

The Healthcare Resort of Shawnee Mission, with a 101-bed licensed transitional care operation and 29 private assisted living suites;

The Healthcare Resort of Olathe, with a 70-bed licensed transitional care operation and 30 private assisted living suites;

The Healthcare Resort of Plano, with a 70-bed licensed transitional care operation and 30 private assisted living suites;

The
Healthcare Resort of Colorado Springs, with a 90-bed licensed transitional care operation and 35 private assisted living suites; and

The Healthcare Resort of Waco, with a 70-bed licensed transitional care operation and 30 private assisted living suites.

These additions bring Ensign's growing portfolio to 208 healthcare operations, thirty-five of which are owned, sixteen hospice agencies, sixteen home health agencies, three home care businesses and fourteen urgent care clinics across fourteen states. Mr. Christensen reaffirmed that Ensign continues to actively seek transactions to acquire real estate and to lease both well-performing and struggling skilled nursing, assisted living and other healthcare related
businesses in new and existing markets.

2016 Guidance

Management reaffirmed its 2016 annual revenue guidance of $1.625 billion to $1.660 billion and adjusted its 2016 annual earnings per share guidance to $1.35 to $1.42 per diluted share. Management's guidance is based on diluted weighted average common shares outstanding of 52.6 million, which includes the impact of the stock repurchases in the first quarter of 2016. In addition, the guidance assumes, among other things, anticipated Medicare and Medicaid reimbursement rate increases net of provider taxes, tax rates of 38.5% and acquisitions closed to date. It also excludes acquisition-related costs and amortization costs related to intangible assets acquired, stock based
compensation, implementation costs for system improvements, costs incurred to recognize income tax credits, results at one closed facility and costs incurred for facilities currently being constructed and other start-up operations and insurance reserves in connection with a settlement of a general liability claim.

2017 Guidance

Management also provided guidance for 2017, with annual revenue guidance of $1.818 billion to $1.842 billion and annual earnings per share guidance of $1.62 to $1.70 per diluted share. Management's guidance is based on diluted weighted average common shares outstanding of 54.2 million and a 36.0% tax rate, both of which reflect the anticipated impact of ASU 2016-09 that will become effective in 2017. In addition, the guidance
assumes, among other things, anticipated Medicare and Medicaid reimbursement rate increases net of provider taxes, tax rates of 36.0% and acquisitions closed to date. It also excludes acquisition-related costs and amortization costs related to intangible assets acquired, stock based compensation, costs incurred to recognize income tax credits and costs incurred for facilities currently being constructed and other start-up operations.

Conference Call

A live webcast will be held Tuesday, August 2, 2016 at 10:00 a.m. Pacific time (1:00 p.m. Eastern time) to discuss Ensign's second quarter financial results. To listen to the webcast, or to view any financial or statistical information required by SEC Regulation G, please visit the Investors
Relations section of Ensign's website at http://investor.ensigngroup.net. The webcast will be recorded, and will be available for replay via the website until 5:00 p.m. Pacific Time on Friday, September 2, 2016.

About Ensign™

The Ensign Group, Inc.'s independent operating subsidiaries provide a broad spectrum of skilled nursing and assisted living services, physical, occupational and speech therapies, home health and hospice services, urgent care services and other rehabilitative and
healthcare services at 208 operations, sixteen hospice agencies, sixteen home health agencies, three home care businesses and fourteen urgent care clinics in California, Arizona, Texas, Washington, Utah, Idaho, Colorado, Nevada, Iowa, Nebraska, Oregon, Wisconsin,
Kansas and South Carolina. Each of these operations is operated by a separate, independent operating subsidiary that has its own management, employees and assets. References herein to the consolidated "company" and "its" assets and activities, as well as the use of the terms "we," "us," "its" and similar terms, are not meant to imply that The Ensign Group, Inc. has direct operating assets, employees or revenue, or that any of the operations, the home health and hospice businesses, the Service Center or the captive insurance subsidiary are operated by the same entity. More information about Ensign is available at
http://www.ensigngroup.net.

This press release contains, and the related conference call and webcast will include, forward-looking statements that are based on management's current expectations, assumptions and beliefs about its business, financial performance, operating results, the industry in which it operates and other future events. Forward-looking statements can often be identified by words such as "anticipates," "expects," "intends," "plans," "predicts," "believes," "seeks," "estimates," "may," "will," "should," "would," "could," "potential," "continue," "ongoing," similar expressions, and variations or negatives of these words. These forward-looking statements include, but
are not limited to, statements regarding growth prospects, future operating and financial performance, and acquisition activities. They are not guarantees of future results and are subject to risks, uncertainties and assumptions that could cause actual results to materially and adversely differ from those expressed in any forward-looking statement.

These risks and uncertainties relate to the company's business, its industry and its common stock and include: reduced prices and reimbursement rates for its services; its ability to acquire, develop, manage or improve operations, its ability to manage its increasing borrowing costs as it incurs additional indebtedness to fund the acquisition and development of operations; its ability to access capital on a cost-effective basis to continue to successfully implement its growth strategy; its operating margins
and profitability could suffer if it is unable to grow and manage effectively its increasing number of operations; competition from other companies in the acquisition, development and operation of facilities; its ability to defend claims and lawsuits, including professional liability claims alleging that our services resulted in personal injury, and other regulatory-related claims; and the application of existing or proposed government regulations, or the adoption of new laws and regulations, that could limit its business operations, require it to incur significant expenditures or limit its ability to relocate its operations if necessary. Readers should not place undue reliance on any forward-looking statements and are encouraged to review the company's periodic filings with the Securities and Exchange Commission, including its Form 10-Q, for a more complete discussion of the
risks and other factors that could affect Ensign's business, prospects and any forward-looking statements. Except as required by the federal securities laws, Ensign does not undertake any obligation to publicly update or revise any forward-looking statements, whether as a result of new information, future events, changing circumstances or any other reason after the date of this press release.

(4) Facility Closed represent the result of one facility closed during
the first quarter of 2016. These results were excluded from Same Facility results for three months ended June 30, 2016 and 2015 for comparison purposes.

Six Months EndedJune 30,

2016

2015

(Dollars in thousands)

Change

% Change

Total Facility Results:

Skilled nursing revenue

$

655,631

$

530,179

$

125,452

23.7

%

Assisted and independent living revenue

60,877

30,230

30,647

101.4

%

Total TSA services revenue

$

716,508

$

560,409

$

156,099

27.9

%

Number of facilities at period end

206

150

56

37.3

%

Actual patient days

2,842,504

2,198,396

644,108

29.3

%

Occupancy percentage — Operational beds

76.7

%

78.4

%

(1.7

)

%

Skilled mix by nursing days

31.9

%

30.2

%

1.7

%

Skilled mix by nursing revenue

53.6

%

53.2

%

0.4

%

Six Months EndedJune 30,

2016

2015

(Dollars in thousands)

Change

% Change

Same Facility Results(1):

Skilled nursing revenue

$

449,545

$

427,549

$

21,996

5.1

%

Assisted and independent living revenue

18,467

18,280

187

1.0

%

Total TSA services revenue

$

468,012

$

445,829

$

22,183

5.0

%

Number of facilities at period end

106

106

—

—

%

Actual patient days

1,698,652

1,694,987

3,665

0.2

%

Occupancy percentage — Operational beds

79.4

%

80.3

%

(0.9

)

%

Skilled mix by nursing days

30.9

%

30.3

%

0.6

%

Skilled mix by nursing revenue

52.3

%

53.5

%

(1.2

)

%

Six Months EndedJune 30,

2016

2015

(Dollars in thousands)

Change

% Change

Transitioning Facility Results(2):

Skilled nursing revenue

$

86,223

$

80,640

$

5,583

6.9

%

Assisted and independent living revenue

9,341

8,755

586

6.7

%

Total TSA services revenue

$

95,564

$

89,395

$

6,169

6.9

%

Number of facilities at period end

29

29

—

—

%

Actual patient days

374,345

364,555

9,790

2.7

%

Occupancy percentage — Operational beds

73.7

%

71.8

%

1.9

%

Skilled mix by nursing days

34.5

%

31.4

%

3.1

%

Skilled mix by nursing revenue

56.4

%

54.2

%

2.2

%

Six Months EndedJune 30,

2016

2015

(Dollars in thousands)

Change

% Change

Recently Acquired Facility Results(3):

Skilled nursing revenue

$

119,243

$

18,331

$

100,912

NM

Assisted and independent living revenue

33,069

3,195

29,874

NM

Total TSA services revenue

$

152,312

$

21,526

$

130,786

NM

Number of facilities at period end

71

14

57

NM

Actual patient days

766,262

120,913

645,349

NM

Occupancy percentage — Operational beds

72.5

%

74.5

%

NM

Skilled mix by nursing days

33.9

%

26.3

%

NM

Skilled mix by nursing revenue

56.5

%

46.9

%

NM

Six Months EndedJune 30,

2016

2015

(Dollars in thousands)

Change

% Change

Facility Closed(4):

Skilled nursing revenue

$

620

$

3,659

$

(3,039

)

NM

Assisted and independent living revenue

-

-

-

NM

Total TSA services revenue

$

620

$

3,659

$

(3,039

)

NM

Actual patient days

3,245

17,941

(14,696

)

NM

Occupancy percentage — Operational beds

70.7

%

72.4

%

NM

Skilled mix by nursing days

9.6

%

13.0

%

NM

Skilled mix by nursing revenue

14.0

%

31.6

%

NM

_______________________

(1) Same Facility results represent all facilities purchased prior to January 1, 2013.

(2) Transitioning Facility results represents all facilities purchased from January 1, 2013 to December 31, 2014.

(4) Facility Closed represent the result of one facility closed during the three and six months ended June 30, 2016. These results were excluded from Same Facility results for six months ended June 30, 2016 and 2015 for comparison purposes. Included in the six months ended June 30, 2016 results is one month of operation as the facility was closed in February 2016; as such, the metrics are not comparable to the results during the six months ended June 30, 2015.

THE ENSIGN GROUP, INC. SKILLED NURSING AVERAGE DAILY REVENUE RATES AND PERCENT OF SKILLED NURSING REVENUE AND DAYS BY PAYOR

The following table reflects the change in the skilled nursing average daily revenue rates by payor source, excluding services that are not covered by the daily rate:

Three Months Ended June 30,

Same Facility

Transitioning

Acquisitions

Total

2016

2015

2016

2015

2016

2015

2016

2015

Skilled
Nursing Average Daily Revenue Rates:

Medicare

$

581.48

$

562.69

$

557.12

$

555.42

$

494.81

$

452.97

$

555.11

$

554.72

Managed care

424.79

421.17

461.67

458.59

409.62

428.20

427.43

428.94

Other skilled

468.47

468.38

351.42

324.76

384.43

666.11

440.25

448.95

Total skilled revenue

505.99

499.85

478.37

477.00

453.45

459.54

489.49

494.31

Medicaid

215.90

185.58

190.70

182.54

168.98

185.95

202.11

184.80

Private and other payors

207.64

189.48

213.58

192.98

181.61

193.58

201.41

189.87

Total skilled nursing revenue

$

303.93

$

280.60

$

291.18

$

277.29

$

262.10

$

268.65

$

292.40

$

278.71

Six Months Ended June 30,

Same Facility

Transitioning

Acquisitions

Total

2016

2015

2016

2015

2016

2015

2016

2015

Skilled Nursing Average Daily Revenue Rates:

Medicare

$

580.14

$

564.51

$

557.08

$

556.26

$

492.44

$

451.51

$

556.51

$

558.20

Managed care

423.08

416.35

463.87

461.45

410.07

412.68

427.65

425.87

Other skilled

467.33

473.75

350.59

324.95

389.41

669.14

439.46

456.13

Total skilled revenue

503.07

500.66

478.42

480.87

451.99

461.00

488.82

496.10

Medicaid

206.35

189.91

189.43

183.02

175.67

184.53

198.28

188.20

Private and other
payors

203.57

189.94

223.90

202.20

190.29

190.81

203.59

191.62

Total skilled nursing revenue

$

297.95

$

284.22

$

292.81

$

278.95

$

271.05

$

258.71

$

291.81

$

281.59

The following tables set forth our percentage of skilled nursing patient revenue and days by payor source for the three months ended June 30, 2016 and 2015:

Three Months Ended June 30,

Same Facility

Transitioning

Acquisitions

Total

2016

2015

2016

2015

2016

2015

2016

2015

Percentage of Skilled Nursing Revenue:

Medicare

27.8

%

30.7

%

23.1

%

24.4

%

32.5

%

35.0

%

28.2

%

29.9

%

Managed care

15.6

15.7

26.5

25.0

19.6

11.3

17.8

16.9

Other skilled

7.7

7.2

6.3

5.2

3.5

4.4

6.7

6.6

Skilled mix

51.1

53.6

55.9

54.6

55.6

50.7

52.7

53.4

Private and other payors

7.9

8.2

8.1

8.1

9.2

15.6

8.1

8.6

Quality mix

59.0

61.8

64.0

62.7

64.8

66.3

60.8

62.0

Medicaid

41.0

38.2

36.0

37.3

35.2

33.7

39.2

38.0

Total skilled nursing

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

Three Months Ended June 30,

Same Facility

Transitioning

Acquisitions

Total

2016

2015

2016

2015

2016

2015

2016

2015

Percentage of Skilled Nursing Days:

Medicare

14.4

%

15.3

%

12.1

%

12.2

%

17.2

%

20.8

%

14.8

%

15.0

%

Managed care

11.1

10.5

16.7

15.1

12.5

7.1

12.1

11.0

Other skilled

4.9

4.3

5.3

4.5

2.4

1.7

4.4

4.1

Skilled mix

30.4

30.1

34.1

31.8

32.1

29.6

31.3

30.1

Private and other payors

12.3

12.1

10.9

11.5

13.3

21.8

12.3

12.6

Quality mix

42.7

42.2

45.0

43.3

45.4

51.4

43.6

42.7

Medicaid

57.3

57.8

55.0

56.7

54.6

48.6

56.4

57.3

Total skilled nursing

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

The following tables set forth our percentage of skilled nursing patient revenue and days by payor source for the six months ended June 30, 2016 and 2015:

Six Months Ended June 30,

Same Facility

Transitioning

Acquisitions

Total

2016

2015

2016

2015

2016

2015

2016

2015

Percentage of Skilled Nursing Revenue:

Medicare

28.0

%

31.1

%

22.9

%

23.8

%

32.7

%

31.4

%

28.2

%

29.9

%

Managed care

16.5

15.4

27.0

26.0

19.5

9.7

18.4

16.8

Other skilled

7.8

7.0

6.5

4.4

4.3

5.8

7.0

6.5

Skilled mix

52.3

53.5

56.4

54.2

56.5

46.9

53.6

53.2

Private and other payors

7.9

8.0

8.1

8.6

8.5

17.0

8.1

8.5

Quality mix

60.2

61.5

64.5

62.8

65.0

63.9

61.7

61.7

Medicaid

39.8

38.5

35.5

37.2

35.0

36.1

38.3

38.3

Total skilled nursing

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

Six Months Ended June 30,

Same Facility

Transitioning

Acquisitions

Total

2016

2015

2016

2015

2016

2015

2016

2015

Percentage of Skilled Nursing Days:

Medicare

14.3

%

15.6

%

12.0

%

11.9

%

18.0

%

18.0

%

14.7

%

15.1

%

Managed care

11.6

10.5

17.0

15.7

12.9

6.1

12.5

11.1

Other skilled

5.0

4.2

5.5

3.8

3.0

2.2

4.7

4.0

Skilled mix

30.9

30.3

34.5

31.4

33.9

26.3

31.9

30.2

Private and other payors

11.9

12.1

10.7

11.9

12.2

23.0

11.8

12.5

Quality mix

42.8

42.4

45.2

43.3

46.1

49.3

43.7

42.7

Medicaid

57.2

57.6

54.8

56.7

53.9

50.7

56.3

57.3

Total skilled nursing

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

100.0

%

THE ENSIGN GROUP, INC. SELECT PERFORMANCE INDICATORS (Unaudited)

The following tables summarize our selected performance indicators for our home health and hospice segment along with other statistics, for each of the dates or periods indicated:

Three Months EndedJune 30,

2016

2015

Change

% Change

(Dollars in thousands)

Results:

Home health and hospice revenue

Home health services:

$

14,416

$

11,294

$

3,122

27.6

%

Hospice services:

14,077

8,650

5,427

62.7

Total home health and hospice revenue

$

28,493

$

19,944

$

8,549

42.9

%

Home health services:

Medicare Episodic Admissions

2,037

1,672

365

21.8

%

Average Medicare Revenue per Completed Episode

$

2,950

$

2,954

$

(4

)

(0.1

)

%

Hospice services:

Average Daily Census

898

562

336

59.8

%

Six Months EndedJune 30,

2016

2015

Change

% Change

(Dollars in thousands)

Results:

Home health and hospice revenue

Home health services:

$

28,324

$

21,656

$

6,668

30.8

%

Hospice services:

26,835

16,604

10,231

61.6

Total home health and hospice revenue

$

55,159

$

38,260

$

16,899

44.2

%

Home health services:

Medicare Episodic Admissions

4,194

3,415

779

22.8

%

Average Medicare Revenue per Completed Episode

$

2,937

$

2,984

$

(47

)

(1.6

)

%

Hospice services:

Average Daily Census

871

552

319

57.8

%

THE ENSIGN GROUP, INC. REVENUE BY PAYOR SOURCE

The following table sets forth our total revenue by payor source and as a percentage of total revenue for the periods indicated:

Three Months Ended June 30,

Six Months Ended June 30,

2016

2015

2016

2015

$

%

$

%

$

%

$

%

Revenue:

(Dollars in thousands)

(Dollars in thousands)

Medicaid

$

132,763

32.3

%

$

100,873

32.4

%

$

250,338

31.6

%

$

202,502

32.8

%

Medicare

119,443

29.1

95,396

30.7

229,721

28.9

189,752

30.7

Medicaid—skilled

20,661

5.0

16,745

5.4

42,327

5.3

32,282

5.3

Total

272,867

66.4

213,014

68.5

522,386

65.8

424,536

68.8

Managed care

65,178

15.9

47,633

15.3

129,721

16.4

93,963

15.2

Private and other(1)

72,472

17.7

50,409

16.2

141,643

17.8

99,086

16.0

Total revenue

$

410,517

100.0

%

$

311,056

100.0

%

$

793,750

100.0

%

$

617,585

100.0

%

(1) Private and other payors also includes revenue from urgent care centers and other ancillary operations.

(b) Represent operating results for facilities currently being constructed and other start-up operations.

Three Months Ended June 30,

Six Months Ended June 30,

2016

2015

2016

2015

Revenue

$

(6,894

)

$

-

$

(10,653

)

$

-

Cost of services

7,343

462

12,464

608

Rent

2,165

7

3,488

7

Depreciation and amortization

180

10

293

10

Total Non-GAAP adjustment

$

2,794

$

479

$

5,592

$

625

(c) Represent results at closed facility during the three and six months ended June 30, 2016, including fair value of continued obligation under lease agreement and related closing expenses $7.9 million and operating loss of $0.3 million.

Three Months Ended June 30,

Six Months Ended June 30,

2016

2015

2016

2015

Revenue

$

-

$

-

$

(105

)

$

-

Cost of services

207

-

8,436

-

Rent

2

-

58

-

Depreciation and amortization

10

-

14

-

Total Non-GAAP adjustment

$

219

$

-

$

8,403

$

-

(d) Represent stock-based compensation expense incurred.

Three Months Ended June 30,

Six Months Ended June 30,

2016

2015

2016

2015

Cost of services

$

1,316

$

1,119

$

2,529

$

2,081

General and administrative

1,464

614

2,136

1,145

Total Non-GAAP adjustment

$

2,780

$

1,733

$

4,665

$

3,226

(e) Included in cost of services are insurance reserves in connection with the settlement of a general liability claim.

(f) Included in general and administrative expense are costs incurred to acquire an operation which are not capitalizable.

(g) Included in general and administrative expense are costs incurred related to new systems implementation and income tax credits which contributed to a decrease in effective tax rate.

(h) Included in general and
administrative expense is breakup fee, net of costs, received in connection with a public auction.

(i) Included in depreciation and amortization are amortization costs related to patient base intangible assets at newly acquired skilled nursing and assisted living facilities.

(j) Included in interest expense are write-offs of deferred financing fees associated with the amendment of credit facility and amortization of deferred financing fees related to the
former revolving credit facility as part of the spin-off transaction.

(k) Represent adjustment to provision for income tax to our historical year to date effective tax rate of 38.5%

The table below reconciles net income to EBITDA, EBITDAR, Adjusted EBITDA and Adjusted EBITDAR for the periods presented:

Three Months EndedJune 30,

Six Months EndedJune 30,

2016

2015

2016

2015

Consolidated Statements of Income Data:

Net
income

11,363

13,233

20,653

28,323

Less: net income (loss) attributable to noncontrolling interests

37

45

155

(37

)

Interest expense, net

1,168

372

2,303

872

Provision for income taxes

7,278

8,379

13,167

17,964

Depreciation and amortization

9,772

6,379

18,069

12,896

EBITDA

29,544

28,318

54,037

60,092

Facility rent—cost of services

30,741

19,066

57,732

38,031

EBITDAR

60,285

47,384

111,769

98,123

EBITDA

$

29,544

$

28,318

$

54,037

$

60,092

Adjustments to EBITDA:

Urgent care center earnings(a)

(811

)

(625

)

(1,867

)

(1,565

)

Costs incurred for facilities currently being constructed and other start-up operations(b)

449

462

1,812

608

Results at closed facility, including continued obligations and closing expenses (c)

206

—

8,331

—

Stock-based compensation expense(d)

2,780

1,733

4,665

3,226

Insurance reserve in connection with the settlement of a general liability claim(e)

1,586

—

1,586

—

Acquisition related costs(f)

748

438

893

590

Costs incurred related to new systems implementation and professional service fees(g)

269

885

947

1,198

Breakup fee, net of costs, received in connection with a public auction(h)

—

—

—

(1,019

)

Rent related to items(a), (b), and (c) above

2,721

527

4,662

1,016

Adjusted EBITDA

$

37,492

$

31,738

$

75,066

$

64,146

Rent—cost of services

30,741

19,066

57,732

38,031

Less: rent related to items(a), (b) and (c) above

(2,721

)

(527

)

(4,662

)

(1,016

)

Adjusted EBITDAR

$

65,512

$

50,277

$

128,136

$

101,161

(a) Operating results at urgent care centers. This amount excludes rent, depreciation and interest of $0.8 million and $1.7 million for the three and six months ended June 30, 2016, respectively, and $0.8 million and $1.6 million for the three and six months ended June 30, 2015, respectively. The results also excluded the net loss attributable to the variable interest entity associated with our urgent care business.

(b) Costs incurred for facilities
currently being constructed and other start-up operations. This amount excludes rent, depreciation and interest of $2.3 million and $3.8 million for the three and six months ended June 30, 2016, respectively. Rent, depreciation and interest expenses were not material for the three and six months ended June 30, 2015.

(c) Results at a closed facility during three and six months ended June 30, 2016, including fair value of continued obligation under the lease agreement and related closing expenses of $7.9 million and operating loss of
$0.2 million for both the three and six months ended June 30, 2016. This amount excludes rent and depreciation of $0.1 million for the six months ended June 30, 2016.

(d) Stock-based compensation expense incurred during the three and six months ended June 30, 2016 and 2015.

(e) Insurance
reserves in connection with the settlement of a general liability claim.

(f) Costs incurred to acquire an operation which are not capitalizable.

(g) Costs incurred related to new systems implementation and income tax credits which contributed to a decrease in effective tax rate.

(h) Breakup fee, net of costs, received in connection with a public auction in which we were the priority bidder.

The table below reconciles net income to EBITDA, EBITDAR, Adjusted EBITDA and Adjusted EBITDAR for each reportable segment for the periods presented:

Three Months Ended June 30,

Six Months Ended June 30,

2016

2015

2016

2015

2016

2015

2016

2015

TSA Services

Home Health and Hospice

TSA Services

Home Health and Hospice

Statements of Income Data:

Income from operations, excluding general and administrative expense(a)

$

36,098

$

35,067

$

4,349

$

2,996

$

66,954

$

72,366

$

7,525

$

5,671

Depreciation and amortization

7,775

4,877

229

224

14,077

9,826

496

445

EBITDA

$

43,873

$

39,944

$

4,578

$

3,220

$

81,031

$

82,192

$

8,021

$

6,116

Rent—cost of services

29,747

18,214

369

276

55,733

36,376

747

535

EBITDAR

$

73,620

$

58,158

$

4,947

$

3,496

$

136,764

$

118,568

$

8,768

$

6,651

EBITDA

$

43,873

$

39,944

$

4,578

$

3,220

$

81,031

$

82,192

$

8,021

$

6,116

Adjustments to EBITDA:

Costs at facilities currently being
constructed and other start-up operations(b)

441

462

8

—

1,773

608

39

—

Results at closed facility,
including continued obligations and closing expenses (c)

206

—

—

—

8,331

—

—

—

Stock-based compensation expense(d)

1,216

1,033

72

61

2,337

1,913

138

122

Insurance reserve in connection with the settlement of a general liability claim(e)

1586

—

—

—

1586

—

—

—

Rent related to item(c) and (e)above

2,156

—

9

—

3,470

—

18

—

Adjusted EBITDA

$

49,478

$

41,439

$

4,667

$

3,281

$

98,528

$

84,713

$

8,216

$

6,238

Rent—cost of services

29,747

18,214

369

276

55,733

36,376

747

535

Less: rent related
to items(c) and (e)above

(2,156

)

—

(9

)

—

(3,470

)

—

(18

)

—

Adjusted EBITDAR

$

77,069

$

59,653

$

5,027

$

3,557

$

150,791

$

121,089

$

8,945

$

6,773

(a) General and administrative expenses are not allocated to any segment for purposes of determining segment profit or loss.

(b) Costs incurred for facilities currently being constructed and other start-up operations. This amount excluded rent, depreciation and interest of $2.3 million
and $3.8 million for the three and six months ended June 30, 2016, respectively. Rent, depreciation and interest expenses were not material for the three and six months ended June 30, 2015.

(c) Results at closed facility during three and six months ended June 30, 2016, including fair value of continued obligation under lease agreement and related closing expenses of $7.9 million and operating loss of $0.2 million for both the three and six months ended June 30, 2016. This amount excluded rent and depreciation of
$0.1 million for the six months ended June 30, 2016.

(d) Stock-based compensation expense incurred during the three and six months ended June 30, 2016 and 2015.

(e) Insurance reserves in connection with the settlement of a general liability claim.

(f) Costs incurred to acquire operations which are not capitalizable.

Discussion of Non-GAAP Financial Measures

EBITDA consists of net income before (a) interest expense, net, (b) provisions for income taxes and (c) depreciation and amortization. EBITDAR consists of net income before (a) interest expense, net, (b) provisions for income taxes, (c) depreciation and amortization and (d) rent-cost of services. Adjusted EBITDA consists of net income before (a) interest expense, net, (b) provisions for income taxes, (c) depreciation and amortization, (d) costs incurred for operations currently being constructed and other start-up operations, excluding depreciation, interest and income taxes, (e) results of a single closed operation, (f) stock-based compensation expense, (g) costs incurred related to new systems implementation, (h) breakup fee, net of costs, received in connection with a public auction in which we were the priority bidder, (i) professional service fees include costs
incurred to recognize income tax credits which contributed to a decrease in effective tax rate, (j) costs incurred to acquire operations which are not capitalized, (k) insurance reserves in connection with the settlement related to a general liability claim and (l) operating results at urgent care centers, excluding depreciation, interest and income taxes. Adjusted EBITDAR consists of net income before (a) interest expense, net, (b) provisions for income taxes, (c) depreciation and amortization, (d) rent-cost of services, (e) costs incurred for facilities currently being constructed and other start-up operations, excluding rent, depreciation, interest and income taxes, (f) results of a single closed operation, (g) stock-based compensation expense, (h) costs incurred related to new systems implementation, (i) break-up fee, net of costs, received in connection with a public auction in
which we were the priority bidder , (j) professional service fees include costs incurred to recognize income tax credits which contributed to a decrease in effective tax rate, (k) costs incurred to acquire operations which are not capitalized, (l) insurance reserves in connection with the settlement related to a general liability claim and (m) operating results at urgent care centers, excluding rent, depreciation, interest and income taxes. The company believes that the presentation of EBITDA, EBITDAR, adjusted EBITDA, adjusted EBITDAR, adjusted net income and adjusted earnings per share provides important supplemental information to management and investors to evaluate the company's operating performance. The company believes disclosure of adjusted net income per share, EBITDA, EBITDAR, adjusted EBITDA and adjusted EBITDAR has economic substance because the excluded revenues and
expenses are infrequent in nature and are variable in nature, or do not represent current revenues or cash expenditures. A material limitation associated with the use of these measures as compared to the GAAP measures of net income and diluted earnings per share is that they may not be comparable with the calculation of net income and diluted earnings per share for other companies in the company's industry. These non-GAAP financial measures should not be relied upon to the exclusion of GAAP financial measures. For further information regarding why the company believes that this non-GAAP measure provides useful information to investors, the specific manner in which management uses this measure, and some of the limitations associated with the use of this measure, please refer to the company's periodic filings with the Securities and Exchange Commission, including its Annual
Report on Form 10-K and Quarterly Report on Form 10-Q. The company's periodic filings are available on the SEC's website at www.sec.gov or under the "Financial Information" link of the Investor Relations section on Ensign's website at http://www.ensigngroup.net.